Importance Gastroesophageal cancer resections are associated with significant
reintervention and perioperative mortality rates.
Objective To compare outcomes following operative and nonoperative reinterventions
between high- and low-mortality gastroesophageal cancer surgical units
Design All elective esophageal and gastric resections for cancer between
2000 and 2010 in English public hospitals were identified from a national
administrative database. Units were divided into low- and high-mortality
units (LMUs and HMUs, respectively) using a threshold of 5% or less
for 30-day adjusted mortality. The groups were compared for reoperations
and nonoperative reinterventions following complications.
Setting Both LMUs and HMUs.
Participants Patients who underwent esophageal and gastric resections for
Exposure Elective esophageal and gastric resections for cancer, with
reoperations and nonoperative reinterventions following complications.
Main Outcomes and Measures Failure to rescue is defined as the death of a patient following
a complication; failure to rescue–surgical is defined as the
death of a patient following reoperation for a surgical complication.
Results There were 14 955 esophagectomies and 10 671 gastrectomies
performed in 141 units. For gastroesophageal resections combined,
adjusted mortality rates were 3.0% and 8.3% (P < .001) for LMUs and HMUs, respectively. Complications
rates preceding reoperation were similar (5.4% for LMUs vs 4.9% for
HMUs; P = .11). The failure to
rescue–surgical rates were lower in LMUs than in HMUs (15.3%
vs 24.1%; P < .001). The LMUs
performed more nonoperative reinterventions than the HMUs did (6.7%
vs 4.7%; P < .001), with more
patients surviving in LMUs than in HMUs (failure to rescue rate, 7.0%
vs 12.5%; P < .001). Overall,
LMUs reintervened more than HMUs did (12.2% vs 9.6%; P < .001), and LMUs had lower failure to rescue
rates following reintervention than HMUs did (9.0% vs 18.3%; P = .001). All P values stated refer to 2-sided values.
Conclusions and Relevance Overall, LMUs were more likely to reintervene and rescue patients
following gastroesophageal cancer resections in England. Patients
were more likely to survive following both reoperations and nonsurgical
interventions in LMUs.